Beneficial effects from β-adrenergic blockade in elderly patients undergoing noncardiac surgery

Michael Zaugg, Thomas Tagliente, Eliana Lucchinetti, Ellis Jacobs, Marina Krol, Carol Bodian, David L. Reich, Jeffrey H. Silverstein

Research output: Contribution to journalArticlepeer-review

204 Scopus citations

Abstract

Background: Perioperative β-blockade has been shown to improve long- term cardiac outcome in noncardiac surgical patients. A possible mechanism for the reduced risk of perioperative myocardial infarction is the attenuation of the excitotoxic effects of catecholamine surges by β- blockade. It was hypothesized that β-blocker-induced alteration of the stress response was responsible for the reported improvements in cardiovascular outcome. Several variables associated with the perioperative use of β-blockade were also evaluated. Methods: Sixty-three patients were randomly assigned to one of three groups: group I, no atenolol; group II, pre- and post-operative atenolol; group III, intraoperative atenolol. Hormonal markers of the stress response (neuropeptide Y, epinephrine, norepinephrine, cortisol, and adrenocorticotropic hormone) were evaluated preoperatively and for 72 h after surgery. Results: Perioperative β-blockade did not significantly alter the hormonal stress response. However, the β- blocked patients showed improved hemodynamic stability during emergence and postoperatively. They also received less fentanyl intraoperatively (27.7%, P < 0.0001), experienced faster early recovery, had lower pain scores, and required less analgesia in the postanesthesia care unit. Cardiac troponin I release was detected in 8 o 19, 4 of 20, and 5 of 20 patients in groups I, II, and III, respectively (not significant). Three patients in group I had cardiac troponin I levels consistent with myocardial infarction. Conclusion: β-blockade does not reduce the neuroendocrine stress response, suggesting that this mechanism is not responsible for the previously reported improved cardiovascular outcome. However, it confers several advantages, including decreased analgesic requirements, faster recovery from anesthesia, and improved hemodynamic stability. The release of cardiac troponin I suggests the occurrence of perioperative myocardial damage in this elderly population, which appears to be independent of the neuroendocrine stress response.

Original languageEnglish
Pages (from-to)1674-1686
Number of pages13
JournalAnesthesiology
Volume91
Issue number6
DOIs
StatePublished - Dec 1999

Keywords

  • Adrenal cortex hormones
  • Cardiac troponin I
  • Myocardial ischemia
  • Neuropeptides
  • Perioperative management

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